Researchers report that for this population, breast cancer risk elevates as soon as eight years after treatment with a median age of diagnosis from 32 to 35 years. By age 45, estimates show that between 12 to 20 percent of women treated with moderate-to high-dose chest radiation (RT) will be diagnosed with breast cancer. Because of this, for the past decade, the recommendation has been to initiate breast cancer surveillance with annual mammography starting at age 25 or eight years after radiation, whichever occurs last.

“We estimate that there are approximately 20,000 to 25,000 women who are 25 years or older who were treated with chest radiation as a child or young adult,” said Kevin C. Oeffinger, MD, Director of Memorial Sloan Kettering Cancer Center's Program for Adult Survivors of Pediatric Cancers, and the study's lead author. “Ideally, every one of these patients should be involved in a regular screening program.”

The study included 625 women, aged 25 through 50, who had been treated with chest RT for a pediatric cancer, and were participants in the Childhood Cancer Survivor Study (CCSS), a multi-institutional cohort comprised of long-term survivors diagnosed with a pediatric malignancy from 1970-1986. To better evaluate this population's breast cancer screening practices, the authors compared their breast cancer screening practices to that of two other similarly aged groups - the first group was comprised of female cancer survivors not treated with chest RT, and the second were siblings of cancer survivors from the full CCSS cohort.

“Moving forward, we must develop targeted interventions and work toward increasing the screening rate.”

Kevin C. Oeffinger, MD

Of women aged 25 through 39 who were treated with chest RT, only 36.5 percent responded that they had a screening mammogram within the past two years; 47.3 percent reported that they had never had a mammogram; and 23.3 percent had a screening or diagnostic mammogram within the previous year. Among women age 40 through 50 who were treated with chest RT, the numbers were slightly higher, with 76.5 percent reporting a screening mammogram within the past two years. This was compared to the group not treated with chest RT who reported 70 percent, and the CCSS sibling group, who reported 67 percent.

“Most young women at risk of breast cancer following chest radiation for a pediatric cancer are not being appropriately screened, highlighting the fact that many women and their physicians are unaware of this risk of breast cancer at a young age,” said Dr. Oeffinger.

According to the assessment, the strongest predictor of mammography in women ages 25 through 39 is having a physician recommendation. The study also points to other factors, such as whether the physician is aware of the risk associated with chest RT, and how women perceive mammography. Having a positive view of screening mammography was associated with an increased likelihood of screening, regardless of age, the authors wrote.

“Moving forward, we must develop targeted interventions and work toward increasing the screening rate,” said Dr. Oeffinger. “We can do this by continuing to educate women about their risk and providing both them and their physician with the necessary information.”

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assessment (uh-SES-ment)

In healthcare, a process used to learn about a patient’s condition. This may include a complete medical history, medical tests, a physical exam, a test of learning skills, tests to find out if the patient is able to carry out the tasks of daily living, a mental health evaluation, and a review of social support and community resources available to the patient.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

breast (brest)

Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

breast cancer (brest KAN-ser)

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

cancer (KAN-ser)

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

cancer screening

Clinical testing designed to identify the presence of a specific cancer in an asymptomatic individual or population thought to be at risk of that specific cancer. The intent is to find cancers at the earliest possible stage in their development, in order to improve the chances for disease cure.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

cohort (KOH-hort)

A group of individuals who share a common trait, such as birth year. In medicine, a cohort is a group that is part of a clinical trial or study and is observed over a period of time.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

diagnosis (DY-ug-NOH-sis)

The process of identifying a disease, such as cancer, from its signs and symptoms.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

diagnostic mammogram (DY-ug-NAH-stik MA-muh-gram)

X-ray of the breasts used to check for breast cancer after a lump or other sign or symptom of breast cancer has been found.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

malignancy (muh-LIG-nun-see)

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Malignant cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of malignancy. Carcinoma is a malignancy that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a malignancy that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a malignancy that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are malignancies that begin in the cells of the immune system. Central nervous system cancers are malignancies that begin in the tissues of the brain and spinal cord. Also called cancer.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

mammogram (MA-muh-gram)

An x-ray of the breast.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

mammography (ma-MAH-gruh-fee)

The use of film or a computer to create a picture of the breast.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

median (MEE-dee-un)

A statistics term. The middle value in a set of measurements.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

pediatric (pee-dee-A-trik)

Having to do with children.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

physician (fih-ZIH-shun)

Medical doctor.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

radiation (RAY-dee-AY-shun)

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

screening (SKREE-ning)

Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), and the Pap test and HPV test (cervix). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

screening mammogram (SKREE-ning MA-muh-gram)

X-rays of the breasts taken to check for breast cancer in the absence of signs or symptoms.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

sibling (SIB-ling)

A person’s brother or sister who has the same parents.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

surveillance (ser-VAY-lents)

In medicine, the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age, or ethnic group.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

survivor (ser-VY-ver)

One who remains alive and continues to function during and after overcoming a serious hardship or life-threatening disease. In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

will (wil)

A legal document in which a person states what is to be done with his or her property after death, who is to carry out the terms of the will, and who is to care for any minor children.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)